Application for New Connection / Disconnection
To build long term customer confidence based on our competence, expertise, professionalism, pride,
integrity and by being great to deal with.
Please read the terms and conditions detailed at the end of this application form and complete all sections.
1. APPLICATION
Applicant's Name (Please provide your full name, including middle
name):
Postal Address:
Contact Phone Number(s):
Email Address:
Site Contact Name (eg. Plumber, builder or main onsite contact
required for confirmation of location):
Site Contact Phone Number:
Site Address (where work is to be carried out):
Lot number
DP Number
If Yes, what is the Resource Consent
application number?
Is this connection required as part of a subdivision?
Yes
No
Number of connections required:
Water
Sewer
PLEASE NOTE:
A diagram of the desired position/s of the new connection/s relative to the Lot boundaries must be attached
to this application. The location of any connection into or from the Council’s underground water and sewer
networks shall be ultimately determined at the appropriate time by the Group Manager Infrastructure Services or
their representative. Council will not accept any unsigned or incomplete application forms.
Location Plan Attached:
YES
NO
5. FEES AND PAYMENT DETAILS
This application will incur a non-refundable application fee of $200.00 for up to two (2) connections payable on
submission of this signed application. All fees include GST. Payment can be made by cheque, EFTPOS or cash.
It is recommended that payment is made electronically using internet banking. Council’s Bank details are:
Name
Bank
Branch
Account Number
Horowhenua District Council
BNZ
Levin
02-0668-0070607-02
Ensure you include your name (e.g. AB SMITH) and the reason for payment (e.g. NEW CONNECT) in the
Particulars and Reference sections when making payment. No action will be taken on your application until
payment has been receipted by Council and matched to your application. To speed things up send evidence of your
payment with your application email.
Should it be necessary for Council to refund part or all of the fee paid, please provide below the details of the bank
account you wish this to be paid to.
Account Name
Bank Account Number
6. DECLARATION
The information provided in this form is correct at the time of completion. I hereby accept the Terms and Conditions
detailed at the end of this application form.
By typing your name in the space provided below, you are 'electronically signing' this form.
Name:
Date:
HDC is committed to being environmentally sustainable, therefore please submit your application
electronically to:
[email protected]
If you require further information please contact a member of our Customer Experience team on:
06 366 0999
OFFICE USE ONLY
Requirements
GPS Required
Yes
Water
Sewer
Pipe Size
Pipe Size
Standard Meter
Yes
Reflux Value
Yes
No
Pressurised Line
Yes
No
Isolating Valve
Yes
No
No
Combined Meter
Yes
No
RPZ and Cage
Yes
No
Restrictor (0.8)
Yes
No
Existing Infrastructure
Water
Sewer
Pipe Material
Pipe Material
Pipe Size
Pipe Size
Authorising Council Officer
Date Authorised
V1
Terms and Conditions for Applicants
1. All connections into or from Council’s underground water and/or sewer networks must be
approved in writing in the correct format by the Group Manager Infrastructure Services,
Horowhenua District Council or their representative.
2. All connections/disconnections into Council’s underground service mains or within public property
shall be undertaken by a Council Approved underground service contractor.
3. Any works carried out in existing road reserve shall be undertaken by a Council Approved
contractor.
4. All works undertaken within the property boundary shall be the responsibility of the property
owner/applicant and must be undertaken by a private contractor. Applicants are advised that
Council’s plumbing and drainage staff must be contacted to ensure the proposed work complies
with regulations. Additional fees could be payable.
5. There must be no disruption to Council services or other residents as a result of any work
undertaken.
6. All new connections will attract the payment of water or sewer rates in the next financial year.
7. For restricted water connections, the supply is limited to 0.8 litres per minute; the recommended
minimum on site storage capacity is 25,000 litres. Additional storage should be considered for fire
fighting purposes.
8. A quotation will be provided for all work undertaken by Council’s approved contractors for
connections and will be sent to the address given on the face of this form (normally within fifteen
(15) working days).
9. If the quote is not accepted by the applicant before the valid date, a new application will need to
be submitted to Council.
10. Payment in full is required prior to commencement of any works.
11. Once approved and payment made to Council, work will normally be completed within fifteen
(15) working days depending on availability of materials and other contractual requirements.
Council's approved contractors are responsible for:
1. The repair costs for any damage to any existing Council services or facilities.
2. Supplying lateral access chambers, meters, tobies, toby boxes and restrictors, when required.
All material, equipment and service provided by Council’s contractors shall be chargeable to
the applicant.
3. Ensuring any required cleaning eyes must be installed at ground level within 500mm of the
property boundary for any gravity sewer laterals.
4. Ensuring any water connections shall be supplied with an approved meter manifold, meter box
and base. Boxes shall be installed at ground level with tobies approx. 300mm deep situated approx
300-500mm in road reserve from the property boundary. Rural water connections shall be of a
restricted nature (1 litre per min) with the appropriate water meter installed.
5. Ensuring that when required, electronic as-built plans or GPS recorded readings in the specified
format for all new connections including water meter numbers must be provided to Council once
installation is complete. These must comply with Council’s “Minimum as-built requirements”.
6. Ensuring that all pipe work must be laid in accordance with the Horowhenua District Council
Standards and connected by a suitably qualified person.
7. Providing Council with evidence, prior to the start of work, that they have insurance cover of at
least$1,000,000.00 for all risks and $1,000,000.00 for public liability.
8. Ensuring that a traffic management plan (TMP) with a minimum compliance with level 1 is
submitted and approved by Council prior to the start of work, as well as having a copy available on
site at all times for inspection.
9. Ensuring that a copy of their health and safety plan is supplied to Council for acceptance prior to
the start of works.
10. Meeting all of the requirements of the health and safety act when undertaking the work.
11. Reinstating all of the disturbed surfaces within the road reserve to the satisfaction of the Group
Manager Infrastructure Services, Horowhenua District Council.